Keeping Fit - Menopause

The permanent end of a woman's menstrual cycle is called menopause . The duration of time it takes for the body to change over to a non-menstruating hormonal structure varies. It may be as short as a year; some women may experience men-opausal signs and occasional periods for up to ten years.

The average age bracket for menopause is between 40 and 50 years of age. However, about 12 percent of women reach menopause between ages 36 and 40; 15 percent between 51 and 55; and 6 percent either earlier than 40 or later than 55. What this means is that menopause can normally occur anywhere between 36 and 56 years of age.

The premenopausal period is the period of time before frequently irregular menstruation or cessation of menstruation. The body begins to undergo changes that may go unnoticed. Ovulation may be irregular and skip menstrual cycles. The estrogen and progesterone levels may lower.

Signs that accompany the premenopausal period include increasing or lessening menstrual flow, skipped or shortened periods, and occasional irregularly timed menstruation.

The perimenopausal period is the onset of noticeable changes. The menstrual cycle may abruptly cease, or become unpredictable and irregular. Hormone levels of estrogen and progesterone continue to decline. Egg production becomes increasingly irregular or ceases entirely. Egg production may or may not correspond to menstrual flow. A woman can continue ovulating without having a period, or may have periods without ovulating.

The most familiar signs of menopause occur during the perimenopausal period. These occurrences should be considered “signs” and not “symptoms,” since they do not represent anything going wrong. They are not a sign of illness.

The one sign that everyone is aware of is the “hot flash.” Referred to as flashes or flushes, this is a rapid increase in blood vessel dilation at the surface of the skin. The skin temperature can rise between four and eight degrees. The internal body temperature may drop with the increase of the surface temperature. A common hot flash pattern is a sudden feeling of extreme warmth, occasionally accompanied by heavy sweating, and chills following, as the internal body temperature cools. For some women, flashes occur daily; for others they may only occur once every several weeks. Some menopausal women never experience them. Many women experience flashes but are not disturbed by them.

Hot flashes at night, which produce heavy sweating and chills, are sometimes referred to as “night sweats.” They may just be nighttime flashes. They can, though, lead to loss of sleep and thereby trigger fatigue, irritability, and insomnia. Problems with sleep should be discussed with your physician.

Dressing for fluctuations in body temperature may help reduce some undesirable side effects. Wear layers of clothing so when you are warm you can take off the top layer. The top layers are available, then, if you get cold later. It is commonly feared by some women that others can tell when one is experiencing a hot flash. This is rarely true; the usual physical response is a slight blush that goes unnoticed by others. Reassurance by friends can help relieve anxiety.

Other signs of menopause that may be problematic or startling when they occur include flooding. This is the sudden onset of a very heavy menstrual flow. It can occur without warning and normal amounts of menstrual protection may not be adequate. As with the hot flashes, this may never happen, or it may happen extremely infrequently, or it may be a recurrent problem. It is, however, usually only a problem in terms of hygiene and embarrassment. Flooding alone is not normally a symptom of an underlying problem. If there is no underlying disease, no surgery or treatment is required for this. If you are distressed by flooding and need reassurance, or if it is accompanied by pain please see a physician.

Vaginal changes that occur during menopause can include a thinning of the vaginal wall. This is normally associated with the reduction of estrogen production. The vagina will produce less lubrication and hold less moisture. The signs of this may include perceived dryness, itching, irritation from walking, and pain or discomfort during intercourse. Because the loss of lubrication may be the underlying cause, using douches and feminine hygiene sprays are not recommended. A water-based lubricant, such as K-Y Jelly™, or moisturizer such as Replens™, is recommended for discomfort, particularly with intercourse. You should avoid oil-based lubricants, such as Vaseline™, as they are more difficult for the body to absorb and may create problems with infection.

Mood swings are also commonly cited as a sign of menopause. They may accompany the hormonal swings of the early stages of menopause or they may occur later. Many women do not have noticeable mood change at all.

The change of mood may be sudden or it may be slow. Depression has been noted by some women and will most likely pass as the body adapts to the new hormonal levels. Knowing that it is caused by hormonal changes may help some women adjust to temporary shifts in mood. Debilitating or distressing changes should always be discussed with your doctor.

The post-menopausal period is the rest of one's life after menopause. The menstrual cycle has ceased entirely. The production of eggs has stopped. The body's production of estrogen and progesterone is very low. The body is back to a stable, predictable physical pattern.

A physician may prescribe estrogen and progesterone supplements to reduce or eliminate some of the adverse reactions to menopause. Hormonal treatment may reduce or eliminate hot flashes and vaginal wall thinning and drying. It can reduce heavy menstrual bleeding. Hormone therapy may also lower a woman's risk of heart disease and stroke and protect against osteoporosis, but it may also increase her risk of breast or uterine cancer. These risks have not been proved, however, and research continues on new types of synthetic estrogen that may be risk-free. The risks and benefits should be discussed with a physician before any treatment is begun.

Hysterectomies

When problems arise with the reproductive organs, or the body's response to the fluctuation in hormone production, surgery may be a solution.

Hysterectomy, the surgical removal of the uterus, and oophorectomy, the surgical removal of the ovaries, are medical procedures done to alleviate major medical problems or remove cancerous tissue. Cancers of the uterus, ovaries, or cervix are frequently treated with removal of the cancerous and surrounding tissue. Hemorrhaging that has not responded to hormonal or other less invasive surgery may be corrected with a hysterectomy.

Other problems that can be alleviated surgically are noncancerous fibroid growths, endometriosis (the uterine tissue invades other tissues), and physical impairment or deterioration of the uterus or ovaries, as is the case with collapse of the uterus through the cervix.

There are several types of hysterectomies, differing in how much of the reproductive system is removed.

A subtotal hysterectomy is the removal of the uterus, leaving the cervix, fallopian tubes, and ovaries in place. A total hysterectomy is the removal of the cervix as well as the uterus. Oophorectemy and ovariectomy are both used to describe the surgical removal of one or both of the ovaries. Ovariohysterectomy is the removal of the ovaries, fallopian tubes, and uterus. The quantity of tissue removed will be determined by the patient and the doctor, based on the reasons for the operation. For removal of cancerous tissue, all organs may need to be removed. For sterilization, only a subtotal hysterectomy may be necessary.

If a woman has not already been through menopause, removal of the ovaries will initiate it.

Although hysterectomies are common, they are still considered major surgery and should be approached as such, by both the doctor and the patient. Recovery can take six weeks or longer.

It has been estimated that four out of five hysterectomies may be unnecessary. Women with abnormal uterine bleeding, fibroid tumors, and other gynecologic conditions should investigate alternatives to hysterectomy, always following the best available medical advice.